Wild, Jennifer L
Wild, Jennifer L is an sole proprietor health care provider with primary practice located at 1483 Sw Bougainvillea Ave , Port Saint Lucie FL 34953-7302. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Wild, Jennifer L can be contacted via phone (772) 336-6928.Contact Information
Primary practice address
1483 Sw Bougainvillea Ave
Port Saint Lucie FL 34953-7302
Phone: (772) 336-6928
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist | 225X00000X | OT8477 | Florida |
Profile Details
| NPI number | 1396867750 |
|---|---|
| LBN Legal business name | Wild, Jennifer L |
| Credentials | Registered Occupational Therapist (OTR) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 5th, 2007 |
| Last updated | Jan 22nd, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396867750 | NPPES |
| Florida | MEDICAID | 884456900 |
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